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Pharmacologic class: Pyranocarboxylic acid, nonsteroidal anti-inflammatory drug (NSAID)
Therapeutic class: Nonopioid analgesic
Pregnancy risk category C (first and second trimesters), D (third trimester)
Blocks activity of cyclooxygenase (which is needed for prostaglandin synthesis), easing pain and reducing inflammation
Capsules: 200 mg, 300 mg
Tablets: 400 mg, 500 mg
Tablets (extended-release): 400 mg, 500 mg, 600 mg
Indications and dosages
➣ Osteoarthritis; rheumatoid arthritis
Adults: 300 mg P.O. two or three times daily; or 400 mg, 500 mg, or 600 mg P.O. b.i.d.; or 400 to 1,000 mg P.O. (extended-release tablets) once daily
➣ Mild to moderate pain
Adults: 200 to 400 mg P.O. q 6 to 8 hours, not to exceed 1,200 mg/day
• Hypersensitivity to drug or its components
• Concurrent use of other NSAIDs
• Active GI bleeding or ulcer disease
Use cautiously in:
• severe cardiovascular, renal, or hepatic disease
• elderly patients
• breastfeeding patients
• children (safety not established).
• Give with food or antacids to reduce GI upset.
• Make sure patient swallows extended-release tablets whole without crushing or chewing.
• Withhold drug several days before invasive surgery, as ordered.
CNS: dizziness, malaise, weakness, depression, nervousness
EENT: blurred vision, tinnitus
GI: nausea, vomiting, constipation, diarrhea, flatulence, dyspepsia, peptic ulcer, duodenitis, intestinal ulceration, gastritis, melena
GU: dysuria, urinary frequency, polyuria, renal failure
Hepatic: cholestatic jaundice, cholestatic hepatitis, hepatic necrosis
Skin: rash, skin peeling, cutaneous vasculitis with purpura, hyperpigmentation
Other: fluid retention, chills, fever, allergic reaction
Drug-drug. Aminoglycosides: elevated aminoglycoside blood level (in premature infants)
Anticoagulants: prolonged prothrombin time
Beta-adrenergic blockers: reduced antihypertensive effect
Bisphosphonates: increased risk of gastric ulcers
Cholestyramine: decreased etodolac absorption
Cyclosporine: increased risk of nephrotoxicity
Diuretics: decreased diuretic effect
Lithium: increased lithium blood level, greater risk of toxicity
Methotrexate: increased risk of methotrexate toxicity
Phenylbutazone: increased etodolac effects
Phenytoin: increased phenytoin blood level
Salicylates: decreased etodolac blood level
Drug-diagnostic tests. Bleeding time: prolonged
Blood urea nitrogen (BUN), creatinine, hepatic enzymes: increased levels
Urine bilirubin, urine ketones: falsepositive results
Drug-herbs. Arnica, chamomile, clove, dong quai, feverfew, garlic, ginkgo, ginseng: increased risk of bleeding
White willow: increased etodolac effects
Drug-behaviors. Alcohol use: increased risk of adverse effects
Sun exposure: phototoxicity
• Monitor CBC, liver function tests, BUN, creatinine level, and coagulation studies.
• Assess for GI bleeding and gastric upset. Administer antacids as needed and prescribed.
• Know that drug may cause falsepositive urine bilirubin and urine ketone test results.
☞ Monitor patient for signs and symptoms of thrombocytopenia and increased bleeding time.
• Assess for fluid retention and weigh patient daily.
• Watch for decreased blood pressure control in hypertensive patients.
• Instruct patient to take with meals if possible.
• Tell patient to swallow extendedrelease tablets whole without crushing or chewing.
☞ Instruct patient to immediately report unusual bleeding or bruising, change in urination pattern, unusual tiredness, or yellowing of skin or eyes.
• Advise patient to avoid activities that can cause injury.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.